Rural workers' health and productivity: an economic assessment of pesticide use in Minas Gerais, Brazil

This paper evaluates the economic impact of pesticide intoxication on the health of rural workers in the State of Minas Gerais, Brazil. To estimate the economic impact we considered the purchase cost of pesticides and the treatment costs of rural workers' affected by intoxication. These impacts were compared to the benefits of pesticide use, as estimated by the crop losses avoided through pesticide application. Data were obtained from the Fundacentro/Ministry of Work agency for the years 1991-2000, in nine municipalities of Minas Gerais, Brazil; and included epidemiological surveillance records and blood screening results. Rural workers' probabilities of intoxication were estimated as a function of their expositure characteristics by means of a logistic regression model. The changes in marginal probabilities associated with changes in expositure characteristics were also estimated. When health intoxication costs are included in the farmer's decision process, the financial benefit of pesticide use with certain crops is reduced. For zucchini, beans and corn, respectively, treatment costs represent about 42%, 25% and 25% of the pesticide use benefit. This study points to the need for an extensive investigation into the real benefits of pesticide use and its consequences for the environment and health in Brazil.     

Factors associated with safe sex among public school students in Minas Gerais, Brazil

A cross-sectional study was conducted to evaluate factors associated with safe sex among sexually active public school students in Minas Gerais State, Brazil. The study focused on correlations between the variables gender, age, schooling, current grade, ethnicity, religion, importance attributed to religion, mothers' education, prior exposure to any sex education, promotion of juvenile protagonism, and participation by health professionals in school activities and consistent condom use with casual or stable partners and with use of other modern contraceptive methods. Bivariate and multivariate logistic regression analyses were used. Male gender and participation by health professionals in school activities were positively associated with all indicators of safe sex, and maternal schooling of more than eight years was positively associated with consistent condom use with casual and stable partners. Secondary (versus elementary) schooling and age (older) were inversely associated with consistent condom use with casual and stable partners, respectively. Ascribing greater importance to religion and Evangelical religion were negatively associated with use of modern contraceptives in the last sexual intercourse.     

The use of psychotropics by dental patients in Minas Gerais, Brazil]

In Brazil, psychotropics and other drugs are often indiscriminately overused. Nevertheless, there are few studies regarding the use of psychotropics, especially among dental patients. The purpose of this study was to assess the prevalence of psychotropic consumption among patients of the general primary care clinic of the Dentistry School at the Minas Gerais Federal University, in Brazil. To collect data, students working in the clinic interviewed all patients over 12 years of age seen at the clinic during June 1997 and asked them about their use of psychotropics during the preceding 2-week and 12-month periods. The results showed that 4% of the patients had used psychotropic drugs in the 2 weeks before the study and that 10% of them had used psychotropics in the preceding 12 months. The drugs used most frequently in the 12-month period were anxiolytics (around 40% of total use). The median age of the patients was 23 years old. Persons under the median had used psychotropics less in comparison with older persons (P < 0.01). A significant association (P < 0.05) was found between using drugs and being female, and also between the use of drugs and being a housekeeper or a housewife (P < 0.03). Patients with a regular relationship (married or living together) used more psychotropics than patients who were single, widowed, or divorced (P < 0.03). There was no association between the use of drugs and the level of education. Even though information on the use of psychotropics is important for dental diagnosis and planning, only 40% of the students said they noted this information in their patients' charts. That fact suggests that dental student education may be lacking in this regard and that dentistry training should take into consideration the issue of patients' use of drugs.     

Fatal spotted fever rickettsiosis, Minas Gerais, Brazil

The emergence and reemergence of a serious infectious disease are often associated with a high case-fatality rate because of misdiagnosis and inappropriate or delayed treatment. The current reemergence of spotted fever rickettsiosis caused by Rickettsia rickettsii in Brazil has resulted in a high proportion of fatal cases. We describe two familial clusters of Brazilian spotted fever in the state of Minas Gerais, involving six children 9 months to 15 years of age; five died. Immunohistochemical investigation of tissues obtained at necropsy of a child in each location, Novo Cruzeiro and Coronel Fabriciano municipalities, established the diagnosis by demonstration of disseminated endothelial infection with spotted fever group rickettsiae. The diagnosis in the two fatal cases from Coronel Fabriciano and the surviving patient from Novo Cruzeiro was further supported by immunofluorescence serologic tests.     

Factors associated with AIDS and AIDS-like syndrome among homosexual and bisexual men in Minas Gerais, Brazil

A case-control study to determine factors associated with AIDS and AIDS-like syndrome among homosexual/bisexual men was conducted in the State of Minas Gerais (Brazil). Eighty-three per cent (45 patients) of all AIDS/AIDS-like syndrome cases in homosexual/bisexual men reported in Minas Gerais between February, 1986 and June, 1987 were compared to 133 seronegative controls seen at the same clinic. Blood samples were tested by ELISA and confirmed by Western blot. Sex with men from the USA, sex with someone who developed AIDS, number of male partners (greater than or equal to 100 lifetime), age (greater than or equal to 30 years old) and ethnicity (white) were independently associated with AIDS/AIDS-like syndrome (Odds Ratios = 5.5, 4.3, 3.9, 3.5 and 2.7, respectively). Thirty-nine per cent of cases and 44% of controls reported bisexual activity during the previous two years. From these, a high proportion reported anal intercourse with women in the same period (53% of bisexual cases and 33% of bisexual controls). Bisexual men had more male partners than female partners in the previous two years (median male partners = 20 for cases and five for controls; median female partners = three for both cases and controls). This explains in part why the epidemic has increased more rapidly among men then among women in Minas Gerais, despite the large proportion of bisexuals with the disease.     

Drinking-and-driving prevalence in Belo Horizonte, Minas Gerais State, Brazil

Problems resulting from alcohol consumption by drivers have been studied worldwide, and epidemiological research points to high injury and death rates related to drinking-and-driving. However, equivalent data are limited in Brazil. In this study, 913 drivers were stopped on public roads with heavy traffic and high concentrations of bars, restaurants, and nightclubs in Belo Horizonte, Minas Gerais State, and asked to answer a questionnaire and submit to an active breathalyzer test. The study was done in December 2005 and December 2006. The study adopted the internationally accepted sobriety checkpoint method. In the sample, 38.0% of drivers showed some trace of alcohol in their exhaled air, and 19.6% were at or above the legal limit (0.6 g/l). These figures were five times those found in similar surveys in other countries. The findings suggest a critical drinking-and-driving problem in Belo Horizonte (and probably elsewhere in Brazil) and the need for on-going research, the development of specific public policies to deal with the problem, and effective enforcement of the existing law.     

Schistosomiasis in an ecotourism area in Minas Gerais State, Brazil

This paper discusses schistosomiasis transmission in S?o José da Serra, a village with a population of 500 in the county of Jaboticatubas, Minas Gerais State, Brazil. The area receives thousands of visitors a year for ecotourism. The study was motivated by a case of acute schistosomiasis involving a couple that spent the 2007 Carnival (Mardi Gras) holiday in the area. Stool tests from 268 local residents (53.6% of the population) showed that 35 (13%) were positive for the infection. A comparison with a previous survey (2005) in the same location showed an increase in the schistosomiasis-positive rate from 9.6% to 12.5%, among the 56 individuals who participated in both surveys. A malacological survey of 65 Biomphalaria glabrata snails showed one specimen (1.5%) eliminating cercariae. In a similar survey in 2005, no positive snail specimens were found. The study indicates that active schistosomiasis transmission is occurring in the area, and that integrated educational programs are needed for both the local community and tourists.     

Factors associated with breastfeeding duration in three cities in the region of Alto Jequitinhonha, Minas Gerais, Brazil

The objective of this study was to identify and analyze variables associated with shorter duration of breastfeeding in the Alto Jequitinhonha region, Minas Gerais, Brazil. This was a cross-sectional study, using retrospective data, in three cities of the region. All children up to 24 months of age were considered in the study, with a total sample of 450 children. Statistical analyses employed the Kaplan-Meier method and Cox regression model. Three variables were found to be associated with breastfeeding duration. Risk of premature interruption was 1.59 [1.08;2.36] times higher if the father had completed the second grade or greater in school, 1.52 [1.00;2.34] times higher if the father did not live with the child, and 3.07 [2.17;4.34] times higher if child had used a pacifier. Thus, greater education of fathers, use of pacifiers by children, and fathers not living with the children were factors associated with shorter duration of breastfeeding.     

Epidemiology and evolution of Zika virus in Minas Gerais,Southeast Brazil

Autochthonous Zika virus (ZIKV) transmission in Brazil was first identified in April 2015 in Brazil, with the first ZIKV-associated microcephaly cases detected in October 2015. Despite efforts on understanding ZIKV transmission in Brazil, little is known about the virus epidemiology and genetic diversity in Minas Gerais (MG), the second most populous state in the country. We report molecular and genomic findings from the main public health laboratory in MG. Until January 2020, 26,817 ZIKV suspected infections and 86 congenital syndrome cases were reported in MG state. We tested 8552 ZIKV and microcephaly suspected cases. Ten genomes were generated on-site directly from clinical samples. A total of 1723 confirmed cases were detected in Minas Gerais, with two main epidemic waves; the first and larger epidemic wave peaked in March 2016, with the second smaller wave that peaked in March 2017. Dated molecular clock analysis revealed that multiple introductions occurred in Minas Gerais between 2014 and 2015, suggesting that the virus was circulating unnoticed for at least 16 months before the first confirmed laboratory case that we retrospectively identified in December 2015. Our findings highlight the importance of continued genomic surveillance strategies combined with traditional epidemiology to assist public health laboratories in monitoring and understanding the diversity of circulating arboviruses, which might help attenuate the public health impact of infectious diseases.     

Human rabies transmitted by dogs: risk areas in Minas Gerais,Brazil, 1991-1999

A retrospective study based on observation with the objective of identifying and characterizing the different risk areas for rabies transmission by dogs took place in Minas Gerais State, Brazil, from 1991 to 1999. Indicators confirmed occurrences of canine and feline rabies, notification of human rabies, and administration of appropriate vaccination. The Minas Gerais State Health System is divided into 25 Regional Health Centers, which are linked to the State Health Department (SES-MG). These Health Centers were utilized in the study. The results of 2,845 records of laboratory diagnosis for canine, feline, and human rabies were analyzed. Consolidated SES-MG reports from 1997 to 1999 for rabies vaccination and notification records for cases of human rabies from the National Health Foundation (FUNASA) were also used. In order to verify the local reality, a semi-structured interview with each regional program director was conducted. Minas Gerais presents four different risk modalities, classified as zero, low, medium, and high.     

A population-based study on factors associated with functional disability among older adults in the Great Metropolitan Belo Horizonte, Minas Gerais State, Brazil

This study assessed factors associated with functional disability in old age in Greater Metropolitan Belo Horizonte, Minas Gerais State, Brazil. The theoretical model was based on predisposing (socio-demographic), extra-individual (social support, use of health services), and intra-individual factors (health conditions). The study was conducted in a probabilistic sample of 1,786 subjects aged > 60 years. The dependent variable was disability defined as mild (some difficulty) or severe (total dependence) in performing at least one basic activity of daily living. Prevalence of disability was 16% (8% mild; 8% severe). Age and worse self-rated health were independently and positively associated with mild and severe disability. Self-reported hypertension and arthritis were associated with mild disability, while diabetes and stroke were associated with severe disability. Severe disability was independently and negatively associated with number of visits by friends in the previous 30 days. According to the results, chronic conditions associated with disability in the study population are preventable, and severely disabled elderly had less extra-family social support.     

Avoidable perinatal deaths in Belo Horizonte,Minas Gerais,Brazil, 1999

The perinatal mortality rate is still high in Belo Horizonte. This study investigated all 826 perinatal deaths taking place in 1999, focusing on the possibility of their prevention, using the Wigglesworth classification. The perinatal mortality rate was 20.2 per one thousand births, and the risk of perinatal death was 20 times higher in children with low birthweight. Some 24.6% of the children weighed more than 2,500g, and the main cause of death in this group was asphyxia during labor. The antepartum cause of death contributed to 30% of all deaths, and 25% of these children weighed more than 2,500g. Some deaths occurred out of hospital, and in some cases the mother arrived at hospital in end-stage labor. About 40% of all perinatal deaths or 60% of all early neonatal deaths could have been prevented, suggesting flaws in prenatal, intrapartum, and neonatal care at both the clinical and health-care organizational levels. To intervene in this situation, progress is needed in improving quality of care and ensuring accountability in the specific health services and the health care system as a whole.     

Environmental and social determinants in schistosomiasis mansoni in Ravena, Minas Gerais, Brazil

This study identified the role of biological and social determinants in the transmission of schistosomiasis mansoni in Ravena, Minas Gerais, Brazil, in 1980. This data was used to characterize the clinical and epidemiological profiles of the endemic desease in the population, allowing for the determination of the efficacy of the potable water supply and the specific treatment of those infected with S. mansoni. The district contains three locations, Ravenopolis, Ravena and Lavapes, where the prevalence of the endemic disease was, 20.1%, 42.6% and 63.9%, respectively. The prevalence in the district was statistically higher in men. The age brackets that displayed differences by gender were 10-14 and 15-19 years. Severity of infection was statistically different among individuals within the 10-14 year bracket in ali three locations, and in the 15-19 year bracket among individuals from Ravenopolis and Ravena. The hepatointestinal form was associated with age, and individuals under 15 years of age presented risk of infection 8.85 times higher than adults. Multivariable analysis of the factors involved in transmission of the disease showed that Lavapes was independently associated with infection. In that area, poor sanitary conditions and the proximity of houses to streams infested with S. marsoni cercariae facilitated infection of neighborhood women while performing domestic activities, as well as men digging sand from the streams for construction. These results show the focal nature of transmission of the endemic requiring specific intervention for effective control of disease.     

Labor process and workers' health in charcoal production in Minas Gerais, Brazil

This study is a tentative approach to the relationship between environmental and occupational health and development in a specific situation: charcoal production in the Jequitinhonha Valley, the poorest region in the State of Minas Gerais, Brazil. The study focuses on the labor process, involving heavy exploitation, hazardous working conditions, and extremely precarious living conditions. Working conditions and activities are described and related to the workers' health situation. Social policies and decisive participation by the various social stakeholders are necessary to change this reality.     

Hearing screening in a public hospital in Belo Horizonte, Minas Gerais State, Brazil: hearing impairment and risk factors in neonates and infants

The objective of this study was to estimate the prevalence of hearing impairment in children in a public hospital in Belo Horizonte, Minas Gerais, Brazil, and to investigate the association with risk factors described in the literature. This study was cross-sectional and retrospective and analyzed 798 newborns and infants evaluated in the Universal Neonatal Hearing Screening Program from June 2002 to December 2003. The risk factors established by the Joint Committee on Infant Hearing in 1994 and Azevedo in 1996 were studied, besides prematurity. Prevalence of hearing impairment was 1.8% (15 cases). A multivariate logistic regression analysis was used to verify associations between risk factors and hearing impairment, showing a significant statistical association (p < 0.05) between hearing loss and suspicion of hearing loss by relatives, hyperbilirubinemia (serum level requiring exchange transfusion), ototoxic drugs, and low birth weight. A significant prevalence of hearing impairment in neonates and infants was confirmed. Attention should thus be focused on risk factors for hearing impairment, using hearing programs that ensure prevention, early detection, and intervention.     

Malaria in the state of Minas Gerais,Brazil, 1980-1992

Epidemiological analysis of malaria in the State of Minas Gerais, Brazil, shows the need for permanent reporting of the endemic-related data in order to maintain clinical suspicion of the infection in any febrile patient. Moreover, it increases the possibility of early aetiological diagnosis. Such reporting aims at improving performance of the local health system. It is important to maintain a well-organized malaria epidemiological surveillance system even in non-endemic areas.